The identification of cancer metastases to the bony vertebral column obligates the treating clinician to make a surgical decision. The consequences of that decision for the patient are significant whether the recommendation is for surgical or non-surgical treatment. If the spine is deemed unstable and at risk for fracture, then the patient will undergo a major spinal operation, and will often spend much of their remaining life recuperating from it. Conversely, the patient whose spine is deemed stable and receives non-surgical treatment risks fracture and possible paralysis if the stability analysis was incorrect. In addition, the metastatic disease usually progresses, and the stability analysis must be repeated at intervals throughout the disease course. The spinal stability decision is empirical and can be inaccurate, even when done by experienced spinal clinicians. This proposal addresses both the stability decision and, for those patients deemed at risk for fracture, the nature of the treatment. Aim 1 describes the development of an automated program that analyzes spinal computerized tomography scans, and calculates the residual load carrying capacity of the affected vertebra. Aim 2 optimizes novel injectable materials to restore the load carrying capacity of the vertebra in a minimally invasive manner, thus decreasing time in recovery and rehabilitation from major spine surgery. Successful achievement of this aim would offer an alternative to open surgery for many of these patients, thus decreasing their rehabilitation time and increasing their family time. Aim 3 addresses validation of both the automated spinal stability analysis and the minimally invasive spinal reconstruction. These in vitro and in vivo Aim 3 preclinical validation studies are requisite steps to position both the Aim 1 automated diagnostic methodology and the Aim 2 minimally invasive surgical treatment methodology closer to the goal of translation to clinical practice. Public Health Relevance Statement (provided by applicant): The computerized spinal stability assessment, for patients who have cancer that has spread to their spine, will offer more accurate diagnosis of the need for spine surgery to the patients, and with a much greater likelihood that the patients and their families can get the evaluation done near their home, saving them time, expense, and inconvenience. The recommendation for non-surgical treatment will be made with increased assurance that the risk of a spine fracture is low. Those patients, who do need surgery, will often chose minimally invasive surgical techniques that will shorten their hospital stay and allow them to return home to their families.